机械通气与乌司他丁治疗急性呼吸窘迫综合症的疗效观察

目的：观察机械通气与乌司他丁治疗急性呼吸窘迫综合症的临床疗效。方法：回顾性分析60例急性呼吸窘迫综合症患者的资料,治疗组（30例）采取机械通气与乌司他丁治疗,对照组（30例）采取机械通气治疗,观察两组的的呼吸频率、PaO2、PaO2／FiO2、PCO2、APACHEII评分、胸片变化、VAP发生率及病死率。结果：治疗组的呼吸频率、Pa02、PaO2/FiO2、PCO2指标均优于对照组（t=-6．39,6．27,24．07,9．82,P〈0．05）;治疗组的VAP发生率20．0％明显小于对照组的36．7％（x^2=5．84,P=0．016〈0．05）;治疗组的病死率3.3％明显小于对照组的16．7％（x^2=5．71,P=0．017〈0．05）。两组之间的APACHEII评分及胸片变化均有明显差异（t=7．14,6．33,P〈0．05）。结论：机械通气与乌司他丁治疗急性呼吸窘迫综合症的临床疗效较好,能够较好地改善肺功能,缓解ARDS患者症状,提高安全可靠性,控制死亡率。     

Respiratory viruses and sudden infant death.

Viruses were shown to be present in the respiratory tract in 200 of 763 cases of the sudden infant death syndrome studied in the nine years 1974-82. Epidemiological and pathological evidence suggested that the distribution of viruses in the sudden infant death syndrome differs between infants aged 3 months or less and those aged over 3 months: the incidence of detection of virus was 14% in the younger group compared with 39% in the older group. The distribution of the viruses in these two groups was compared with that in 1341 live infants with respiratory virus infections. Adenovirus, influenza virus, parainfluenza virus, and rhinovirus had similar distribution among the victims of the sudden infant death syndrome and live controls. The incidence of detection of respiratory syncytial virus was increased in the older infants dying of the sudden infant death syndrome (90% of the cases detected) compared with the older group of live infants (53%). Antibody studies, detection of virus, and epidemiological data suggest that respiratory syncytial virus may be a precipitating factor of sudden death in older infants.     

Respiratory distress syndrome: evaluation of genetic susceptibility and protection by transmission disequilibrium test

Based on epidemiological data and genetic association studies, neonatal respiratory distress syndrome (RDS) is a complex disease with a multigenic background. The genes coding for surfactant proteins (SP) A and B have been assigned as the most likely genes in the etiology of RDS. The major factor predisposing to RDS is prematurity, and thus the phenotype of a very premature newborn infant that does not develop the disease can be regarded as hypernormal. Altogether 107 father-mother-offspring trios were divided into two sets according to the proband's phenotype, to evaluate familial segregation of candidate gene polymorphisms by the transmission disequilibrium test. A set of 76 trios were analyzed for transmission disequilibrium from parents to affected offspring. Another set of 31 trios were studied for allele transmission from parents to hypernormal offspring born very prematurely before the gestational age of 32 weeks. SP-A1-A2 haplotype 6A(2)-1A(0) showed significant excess transmission to affected infants and SP-A1 allele 6A(2) decreased transmission to the hypernormals. The present family study provides strong support for a direct or indirect role of the SP-A alleles as genetic predisposers to RDS in premature infants. The inclusion of parent-hypernormal offspring trios in transmission disequilibrium test is a useful approach to test for genetic protection against a disease.     

The Current Status of the Respiratory Distress Syndrome of the Newly Born

The respiratory distress syndrome (RDS) occurs in 14% of premature infants and is twice as common and twice as lethal in males as in females. Recent work suggests that, during the intrauterine period a disturbance in nutrition of the lung resulting from fetal pulmonary vascular constriction results in alveolar-cell damage and a decrease in pulmonary surface activity with resultant atelectasis. Data on respiratory work levels, oxygen consumption and arterial oxygen tension suggest that there is an oxygen debt in the acute stage of the disease. Such data have further clarified the pathogenesis of the metabolic and respiratory components of the acidosis and the secondary effects thereof. In prevention, prophylaxis of prematurity is of major importance. A program of treatment designed to combat the various aspects of the pathophysiological disturbances is described in the form of a case profile. Modern methods of observation, biochemical control and treatment, as well as the necessity for critical evaluation, suggest that infants with RDS are best cared for in special centres.     

感染与早产儿脑损伤临床关系探讨

目的:探讨感染与早产儿脑损伤(HIE,ICH,CWMD)的临床表现,治疗,预后和预防的关系。方法:对2000年1月-2006年10月214例早产儿进行临床分析。结果:胎膜早破32例,母亲妊高症23例,胎儿宫内窘迫33例,脐带扭转打结7人,母亲妊娠糖尿病4人,胎儿畸形4人;早产儿肺炎101人,早产儿寒冷损伤综合征7人,早产儿急性坏死性小肠结肠炎5人,低血糖症27人,低血钙症13人,早产儿缺氧缺血性脑病(HIE)76人,早产儿颅内出血(ICH)21人,早产儿脑白质损伤(CWMD)3人。早期诊断、合理抗感染治疗可减少早产儿HIE及ICH以及CWMD患儿的神经系统后遗症。结论:早产儿感染与HIE及ICH以及CWMD的关系密切,预防产前、产时、产后感染对减少或减轻早产儿脑损伤至关重要。     

Negative Pressure Artificial Respiration: Use in Treatment of Respiratory Distress Syndrome of the Newborn

Forty-five newborn infants in respiratory failure with respiratory distress syndrome were treated with intermittent negative pressure ventilation (INPV). There was a survival rate of 38% (17/45).All infants were initially treated without nasotracheal intubation. However, 24 of these developed a Paco₂ greater than 70 mm. Hg and were subsequently intubated. Intubation was followed by a decrease in the degree of hypercarbia in each instance and simultaneous increase in Pao₂.Complications encountered during ventilation were: emphysema (one patient), aspiration pneumonia (two patients), septicemia (two patients), misplaced nasotracheal tube (one patient).Follow-up of the 17 surviving patients for periods of four to 36 months disclosed two patients with post-intubation hoarseness. One infant initially had spastic quadriplegia with EEG abnormalities, both of which cleared by 5 months of age. In the remaining 14 infants, the results of physical, neurological and psychological examinations have remained within normal limits.     

老年急性呼吸窘迫综合征肺内及肺外源性危险因素分析

目的:探讨老年急性呼吸窘迫综合征肺内及肺外源性危险因素。方法:回顾性分析130例老年ARDS患者,对其中的肺内及肺外源性危险因素进行分析。结果:肺内源性ARDS病因以误吸和肺炎为主,而肺外源性ARDS则以脓毒血症、大手术后等为主;在死亡上均与多器官功能障碍综合征、呼吸衰竭为主要因素,且两组死亡率接近。结论:在老年急性呼吸窘迫综合征中,肺外源性在器官功能衰竭和氧合指数上重于肺内源性,但是在其他因素和死亡结局上均无明显差异性。     

毒蛇咬伤致急性呼吸衰竭38例救治分析

目的探讨毒蛇咬伤致急性呼吸衰竭的发病机制和治疗措施。方法选择毒蛇咬伤患者38例,应用抗蛇毒血清、机械通气等综合治疗。结果经综合救治措施治疗,38例全部痊愈出院。结论综合救治措施是抢救毒蛇咬伤致急性呼吸衰竭最有效的方法。     

Respiratory and heart rate patterns in infants destined to be victims of sudden infant death syndrome: average rates and their variability measured over 24 hours.

From a prospective study in which 24 hour recordings of the electrocardiogram and respiratory activity (abdominal wall movement) were made on a population of full term infants, 22 recordings were obtained from 16 infants who later were victims of the sudden infant death syndrome. The average heart rate, average heart rate variability, average breath to breath interval, and average breath to breath interval variability over the whole of each recording for the 22 recordings were compared with those from a control group of 324 infants selected at random from the rest of the population. No significance was found in the number of recordings from those infants who suffered the sudden infant death syndrome which lay outside the 5th-95th percentile range of the control group for the four variables studied. In a group comparison no difference was found between the sudden infant death syndrome group and the controls either in terms of the respiratory variables studied or in terms of the average heart rate variability. The results did, however, suggest that there may be a group difference in terms of the average instantaneous heart rate.     

The Wilson-Mikity Syndrome—Case Report and Review of Literature

The Wilson-Mikity Syndrome is a newly described respiratory ailment of very premature infants. It is typified by its characteristic clinical course, with onset after a period of well-being, and radiologic findings of coarse infiltrates alternating with cystic changes. At least four cases have occurred in the last two years at the University of California Medical Center, San Francisco. An exemplary case is given. The pathophysiology of the syndrome appears to relate primarily to abnormal ventilation perfusion relationships resulting from uneven lung compliance. It is suggested that the syndrome results from a distortion of the normal development of the fetal lung.     

早产病因及发病机制的研究现状

早产在妇产科临床上比较常见,其作为围生医学当中的一类重要而复杂的妊娠并发症,对早产儿的预后具有较大危害,严重时可能直接导致早产儿死亡。通常而言,早产患者的临床表现主要是子宫收缩,初期表现为不规律的宫缩,并伴有少量的阴道出血亦或是血性分泌物,进而发展成规律性的宫缩,此过程中宫颈管先发生消退,而后扩张。早产儿的体重大多数低于2500 g,且头围小于33 cm,部分胎儿的器官功能及适应能力与足月儿相比明显较差,常需给予特殊的处理。因此,及时梳理导致早产的原因并分析其发病机制,有利于早期掌握防治早产的基础要点。本文就此展开综述,以期为改善母婴妊娠结局提供理论支持。     

机械通气治疗急性呼吸窘迫综合征的肺复张策略研究

目的:探讨机械通气治疗急性呼吸窘迫综合征(Acute respiratory distress syndrome,ARDS)的肺复张策略的作用。方法:选择2012年1月~2012年12月我院收治的采用机械通气并进行肺复张治疗的ARDS患者94例,根据肺复张方法不同,将所有患者分为对照组和实验组,并比较两组患者的不同时点的氧合指数、肺顺应性及两组出现的并发症。结果:对照组肺复张成功率为72.34%,实验组肺复张成功率为95.75%,X2=38.928,P0.05,两组患者肺复张成功率差异具有统计学意义。两组患者氧合指数、肺顺应性和PaCO2在肺复张实施前比较,差异无统计学意义。肺复张策略实施后24h、48h和72h的氧合指数和PaCO2比较,这三个时点的氧合指数和PaCO2差异具有统计学意义。两组患者肺顺应性在肺复张策略实施后1h、2h和6h比较,t分别=4.939,5.391和5.999,P0.05,此三个时点的肺顺应性差异同样具有统计学意义。对照组气压伤发生率为82.98%,实验组气压伤发生率为59.57%,两组患者气压伤发生率差异具有统计学意义。结论:ARDS的患者在机械通气治疗的过程中上采用肺复张策略,不但可以提高肺复张成功率,改善肺部通气效果,且安全性好,适合临床使用。     

乌司他丁在急性呼吸窘迫综合征的临床应用研究

目的:观察乌司他丁(UTI)对急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的临床应用。方法:选择我院ICU自2008年1月至2011年1月收治的160例ARDS患者作为研究对象,采用随机对照的方法,并且经患者或患者家属知情并签字同意分组。分为UTI组(A组)和对照组(B组)。两组均给予相同综合治疗措施,A组除综合治疗外还给予注射用乌司他丁,每次30万U,每日2次。分别记录两组患者开始治疗、治疗后第3天、治疗第7天的生命体征,动脉血气分析、血生化检查结果、并且记录患者在ICU治疗的转归,应用SPSS13.0软件对结果进行统计学分析。结果:经治疗3天A组呼吸频率低于B组,动脉血气分析提示两组PO2、PO2/FiO2、SaO2均有上升。比较后发现A组PO2、PO2/FiO2、SaO2高于B组(P<0.05),两组PO2、SaO2比较有统计学差异。经治疗3天A组与B组生化指标比较、白细胞计数、肾功及血乳酸均有下降,有统计学差异,P<0.05。全部治疗结束后A组与B组死亡率比较(UTI组34.29%,对照组38.26%,P=0.0097)及机械通气时间比较(UTI组7.54±3.27天,对照组11.78±2.69天,P=0.0086),均有统计学差异。结论:大剂量UTI用于ARDS的临床治疗可有效改善患者氧合指数,减少机械通气时间,降低患者的病死率。     

Aetiology of Acute Respiratory Tract Infections in Hospitalised Children in Cyprus

In order to improve clinical management and prevention of viral infections in hospitalised children improved etiological insight is needed. The aim of the present study was to assess the spectrum of respiratory viral pathogens in children admitted to hospital with acute respiratory tract infections in Cyprus. For this purpose nasopharyngeal swab samples from 424 children less than 12 years of age with acute respiratory tract infections were collected over three epidemic seasons and were analysed for the presence of the most common 15 respiratory viruses. A viral pathogen was identified in 86% of the samples, with multiple infections being observed in almost 20% of the samples. The most frequently detected viruses were RSV (30.4%) and Rhinovirus (27.4%). RSV exhibited a clear seasonality with marked peaks in January/February, while rhinovirus infections did not exhibit a pronounced seasonality being detected almost throughout the year. While RSV and PIV3 incidence decreased significantly with age, the opposite was observed for influenza A and B as well as adenovirus infections. The data presented expand our understanding of the epidemiology of viral respiratory tract infections in Cypriot children and will be helpful to the clinicians and researchers interested in the treatment and control of viral respiratory tract infections.     

急性呼吸窘迫综合征临床治疗观察及预后影响因素分析

目的:观察急性呼吸窘迫综合征临床治疗效果,并对预后影响因素进行分析。方法:回顾性分析2006年3月~2011年10月在我院接受治疗的56例急性呼吸窘迫综合征患者的临床资料,使用SPSS12.0进行统计分析,并进行多因素Logistic回归分析。结果:采用以PEEP为主的综合治疗,并联合使用血必净注射液和乌司他丁,治疗ARDS病死率为26.8%;预后影响因素中ARDS并发MODS、APACHEⅡ评分和发病至接受治疗时间具有显著意义。结论:该治疗方法病死率较低,效果良好;ARDS并发并发MODS、APACHEⅡ评分和发病至接受治疗时间是影响ARDS患者的病死预后主要因素。     

The Intensive Respiratory Care Unit—An Approach to the Care of Acute Respiratory Failure

An organized approach for the management of acute respiratory failure in an intensive general care unit utilizes a team of consultants including a general physician, a surgeon, respiratory care nurses, physical therapists and a blood gas technician. Because this team provides consultation and technical assistance in respiratory care and provides the equipment as well as the monitoring of care, this approach is suitable for any hospital interested in the management of acute respiratory emergencies.     

Neonatal pneumopericardium.

Summary: Pneumopericardium developed in three newborn infants, including a set of twins, with respiratory distress syndrome. The rarity of this condition and its occurrence in two newborns suggest an anatomic predisposition, especially in premature infants requiring assisted ventilation. Two of the infants died; one had undergone pericardiocentesis. From a review of the literature and from our cases we conclude that conservative therapy appears warranted in cases of isolated pneumopericardium although the number of cases reported is too small to provide a definite answer.     

无创通气在AECOPD机械通气患者撤机中的研究

目的：通过前瞻性随机对照研究比较应用NIPPV与PSV两种撤机方法在治疗AECOPD合并II型呼吸衰竭进行机械通气撤机困难患者中的优越性。方法：达到撤机标准但经两小时自主呼吸试验（SBT）失败的患者被分为两组：PSV组和无创通气组。观测有创通气时间、机械通气总时间、再插管率、住呼吸重症监护室时间和VAP发生率等指标。结果：NIPPV组较PSV组气管插管时间显著缩短,VAP发生率、再插管率及住院费用均较PSV通气组显著降低。结论：采用无创通气撤机法治疗AECOPD合并II型呼吸衰竭较传统的机械通气方式在有效缩短有创通气时间,降低VAP发生率,改善患者预后方面更优越。     

AECOPD并重度呼吸衰竭患者有创机械通气的治疗时机探讨及其预后的影响因素分析

摘要 目的：探讨慢性阻塞性肺疾病急性加重（AECOPD）合并重度呼吸衰竭患者有创机械通气的治疗时机,并分析其预后的影响因素。方法：选取2020年3月~2021年12月期间于首都医科大学附属北京世纪坛医院治疗的161例AECOPD合并重度呼吸衰竭患者,按照气管插管时间分为早期组（n=89）和延期组（n=72）,对比两组治疗后临床指标、血气分析指标及28 d内病死率（预后）。根据预后的不同将患者分为死亡组（n=29）和存活组（n=132）,收集患者的一般资料和实验室资料,采用Logistic回归分析预后的影响因素。结果：早期组的总机械通气时间、有创通气时间、重症监护室（ICU）住院时间均短于延期组（P<0.05）。两组治疗后动脉血二氧化碳分压（PaCO₂）较治疗前下降,氧合指数（OI）、动脉血氧分压（PaO₂）较治疗前升高,且早期组变化程度大于延期组（P<0.05）。延期组28 d内病死率为15/72（20.83%）。早期组28 d内病死率为14/89（15.73%）,两组患者的28 d病死率对比无差异（P>0.05）。单因素分析结果显示,AECOPD合并重度呼吸衰竭患者的预后影响因素与并发呼吸机相关肺炎、并发多脏器功能不全综合征、年龄、PaCO₂、血红蛋白（Hb）、血尿素氮（BUN）、白细胞计数（WBC）、pH值、中性粒细胞计数/淋巴细胞计数比值（NLR）、血小板计数/淋巴细胞计数（PLR）、C反应蛋白（CRP）、D-二聚体（D-D）、B型尿钠肽有关（P<0.05）。AECOPD合并重度呼吸衰竭患者预后不良的危险因素主要有并发呼吸机相关肺炎、并发多脏器功能不全综合征、PaCO₂偏高、年龄偏大、Hb偏低、pH值偏低、D-D偏高（P<0.05）。结论：AECOPD合并重度呼吸衰竭患者早期使用有创机械通气,可有效改善血气分析,缩短有创通气时间、总机械通气时间、ICU住院时间。并发呼吸机相关肺炎、并发多脏器功能不全综合征、PaCO₂偏高、年龄偏大、Hb偏低、pH值偏低、D-D偏高均是导致AECOPD合并重度呼吸衰竭患者预后不良的危险因素。